Cystic Fibrosis: Helping Your Child Cough Up Mucus

Introduction

Cystic fibrosis causes
mucus to become thick and sticky, which can clog the
lungs and cause serious problems. You can help your child maintain lung
function and avoid complications from mucus buildup and blockage by performing
an airway clearance technique (ACT). Postural drainage and chest percussion (PD
& P) is one of several airway clearance techniques that help clear mucus
from your child's lungs.

To help keep the lungs clear, it is important
to do an airway clearance technique (such as postural drainage and chest
percussion) every day. PD & P works well when used
regularly.

These techniques are one part of a larger treatment plan
for cystic fibrosis.

You may not notice an improvement in your
child's lung function right away. But stopping these
treatments will cause decreased lung function after about 3 weeks in children
who have mild to moderate lung problems.1

It is important for your child to visit his or her doctor
regularly and make any needed changes in treatment.

How do I do postural drainage?

There are several
postural drainage positions. The different positions help drain mucus from
different sections of the lungs. All people who have cystic fibrosis should
do all the positions except babies, who should not be placed in the
head-down position ("tipping"). Tipping a baby can cause reflux, which is when
the contents of the stomach enter the esophagus.

Talk to your
doctor or your
respiratory therapist before starting PD & P. He
or she can show you how the treatment is done and tell you how often and how
long the treatment should be. Most doctors recommend that PD & P be done at
least once a day.

PD & P is a time-consuming process. It
usually takes 20 to 30 minutes. In general, a baby or small child who has no
symptoms of congestion may require less treatment time than an older child who
sounds congested and is coughing a lot.

At first, PD & P can
seem complicated. But with help and practice, the treatment becomes easier,
especially when you notice the benefits to your child. It is important to do
these exercises exactly as instructed.

Before you start, gather
the materials you need, such as tissues, pillows, a thin cloth, or towels. If
you have a baby or small child, you may sit in a chair with the child in your
lap. If your child is older, he or she may be in bed using pillows for the
different positions. You may need to experiment to find the best place to do
the treatment so that both you and your child are
comfortable.

Position your child. Your
doctor or therapist will recommend certain positions to use.

Clap your child's back or chest with your cupped hand quickly and rhythmically. This loosens the mucus,
allowing it to drain. Do not clap directly on the skin—cover the area with thin
clothing or a cloth. Bend your hand at the wrist and
form a cup. When you clap, you should hear a hollow "popping" sound. If you
hear a slapping sound, your hand is not cupped enough. You may safely clap over
the ribs, but do not clap below the lower ribs or over the spine or female breasts.
Follow this procedure for each position.

How much force to use while clapping, and how long you clap, depends on the
child. Consider the following:

Younger and smaller children require less
force and time than older and larger children or teens.

Watch the
child for signs of pain and discomfort. If you notice this, you may be using
too much force.

Is your child congested but mucus isn't coming up? If so, you may need to use
more force.

After clapping, apply vibrations. At the end of each position, you can vibrate the chest area
to help loosen and move mucus. Have your child take a big breath and blow it
out forcefully. As the child is blowing out, place your hand over the chest
area and apply a little bit of pressure. Then quickly contract and relax your
arm and shoulder muscles to produce vibrations throughout the chest area. To
get the most out of this technique, ask your doctor or respiratory therapist to
teach you how to do it properly. When your child is old enough, having his or
her cooperation will make it easier to do this technique.

After vibrations, have your child huff and cough. A huff is a forced exhalation that moves mucus higher and makes
it possible to cough up more mucus. Huffing is best learned through
demonstration, so ask your doctor or respiratory therapist to show you and your
child how to do it. Huffing involves taking a deep breath and then breathing
out forcefully, saying "huff." Your child will do this 2 or 3 times before he
or she coughs. If huffing is done well, you can actually hear the mucus moving
upwards. Your child will spit out the mucus that comes up.

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